Introduction

This is a very exciting time to be a nurse and in sexual healthcare. Deteriorating sexual health in the United Kingdom (UK), with increases in bacterial and viral sexually transmitted infections, including HIV, are putting a huge strain on sexual health services (PHLS, 2002). This has caused two things to happen. Firstly, in an attempt to improve patient throughput, a number of services are reviewing and challenging practices that have been around for years. For example, some clinics have stopped undertaking microscopy on asymptomatic women, while others have stopped urethral gonorrhoea cultures in asymptomatic patients. Perhaps this challenge to existing practice might not have happened without the increased burden on clinics. Secondly, nurses and other healthcare professionals are examining and redefining their roles in order to meet the increasing demands on clinical services. This has caused role delineation to become blurred as doctors, nurses and health advisers adapt their practice to meet these demands whilst constrained by both financial and environmental pressures.

Early in 2005, the Nursing and Midwifery Council (NMC) (NMC, 2005) conducted a consultation about the registration of a second level of practice beyond that of initial registration. It acknowledges that some nurses are working at a different (advanced) level and that registration of this would offer the public great protection. There was also a consultation by the Medicines and Healthcare products Regulatory Authority (MHRA) (MHRA, 2005) in 2005 looking at the extended nurse prescribers' formulary. This was because there were a number of problems with the limited formulary. There were anomalies, which caused confusion, and the formulary was not responsive to changing healthcare practice. To keep abreast of these changes meant that the formulary had to be reviewed regularly, which was expensive and time-consuming. This deterred a number of nurses and pharmacists from undertaking the course, as it didn't meet the needs of a large number of prescribers. Following the consultation an announcement was made in November 2005 by the Department of Health that extended nurse prescribers would be able to prescribe any licensed medicines for any medical condition with the exception of controlled

Finally, both sexual health and nursing in general have been in the spotlight. This began with The NHS Plan (DH, 2000), followed by The National Strategy for Sexual Health and HIV (DH, 2001) and its implementation plan (DH, 2002). There was also a position statement from the Sexual Health Working Group of the London Standing Conference for Nurses, Midwives and Health Visitors (LSC, 2002), the Sexual Health Competencies, competency framework for nurses in sexual health (RCN, 2004) and Effective Commissioning for Sexual Health Services (DH, 2003), the House of Commons Health Select Committee report on sexual health services (Health Select Committee 2003), and the public white paper Choosing Health: Making Healthy Choices Easier (DH, 2004). Finally, in 2005 came the Medfash Recommended Standards for Sexual Health Services (2005) and the BASHH standards for sexual health services consultation document (BASHH, 2005), all of which have placed nursing and sexual health very much on the national agenda. Therefore, in order to define advanced practice this chapter will:

1. Briefly explore the main drivers that explain why healthcare delivery is changing;

2. Explore contemporary nursing roles;

3. Examine the difference between specialist and advanced practice;

4. Document the history of advanced practice;

5. Define advanced practice and the educational preparation thereof; and